>Acta Ortopédica Mexicana
>Year 2002, Issue 3
Olivares-Escutia J, Delbouis-Molina AL, Fernández-Mezo JN, Escalante-Magańa JR, López-Ramos M, Sandoval-Chávez R, Chávez-Flor LF
Treatment for chronic wounds with ulceration by small intestine submucosa. Report of 20 cases
Acta Ortop Mex 2002; 16 (3)
PDF: 4. Kb.
Objective. The present treatment has been proposed for those cases in whom chronic extensive wounds have a delayed cicatrization and prone the patients into an underdog way of life, as a result of frequent attendance to hospital and impairment in daily activities. Wound dressing with a processed layer of porcine small intestinal submucosa has the objective to accelerate the ulceration healing, which is advised as a result of the high content in protein, lipid and carbohidrate of its extracelular matrix. Material and methods. One layer of Oasis® as it is known the sterilized intestinal submucosa, is shaped according to the size of ulceration, exceeding in one inch around the contour of the exposed tissue. Layer is reconstituted by saline and applied over the lesion. Wet gauze, nylon tissue and gentile compressive bandage that protect the layer, must be retired every 5 to 7 days to repeat the procedure until complete healing is obtained. Twenty adult cases of both genders aged 36.3 years in average (13 to 82), who had loss of skin in areas from 1 to 20 cm in their greater diameter, most of them in lower limbs, were treated by the present method. Results. Complete healing was obtained in all but 2 patients. The span for treatment varied from one application, which was required in 5 cases, to 14 sessions in one case. Treatment was abandoned by one woman because of intense pain while in transportation as a result of diabetic neuritis, as well as by other one in whom surgical closure was tried upon patient’s request. Final results in those cases of wound healing were excellent. No case of allergenic reaction was observed. Conclusion. Abundance of nutrient resources contained in the matrix of the submucosa layer, enhances the host cells ingrown until epitelizing, which occurs at a speed depending on how deep is the ulceration to be treated. No allergy was evoked in any case since layer matrix is acelular. Significant cost-treatment economy was ensured since the layer applications are performed as an outpatient procedure.
||ulceration, injury, skin, graft, intestinal submucosa.
Badylak SF. Small intestinal submucosa (SIS): a biomaterial conducive to smart tissue remodeling. Tissue Engineering: Current Perspectives. Bell E (ed). Burkhauser Publishers, Cambridge, MA; 1993: 179-189.
Bell E. Strategy for the selection of scaffolds for tissue engineering. Tissue Eng 1995; 1: 163-179.
Cheng EY, Kropp BP. Urologic tissue engineering with small-intestinal submucosa: potential clinical applications. World J Urol 2000; 18: 26-30.
Ferrand BK, Kokini K, Badylak KL, Geddes LA, Hiles MC, Morff RJ. Directional porosity of porcine small-intestinal submucosa. J Biomed Mater Res 1993; 27: 1235-1241.
Gallico III GG, O’Connor NE. Cultured epithelium as a skin substitute. Clin Plast Surg 1985; 12(2): 149-157.
Gloeckner DC, Sacks MS, Billiar KL, Bacharach N. Mechanical evaluation and design of a multilayered collagenous repair biomaterial. J Biomed Mater Res 2000; 52: 365-373.
Hiles MC, Badylack SF, Geddes LA, Kokini K, Morff RJ. Porosit of porcine small intestinal submucosa for use as a vascular graft. J Biomed Mater Res 1993; 27: 139-144.
Hodde JP, Badylak SF, Brightman AO, Voytik-Harbin SL. Glycosaminoglycan content of small intestinal submucosa: a bioscaffold for tissue replacement. Tissue Eng 1996; 2: 209-217.
Hunt TK. editor: Wound healing and wound infection: theory and surgical practice, New York, Appleton-Century-Crofts. 1980.
McPherson TB, Badylak SF. Characterization of fibronectin derived from porcine small intestinal submucosa. J Biomed Mater Res 1999; 46: 1-10.
Mertz PM, Marshall DA, Eaglstein WH. Occlusive wound dressing to prevent bacterial invasion and wound infection. J Am Acad Dermatol 1985; 12: 662.
Prevel CD, Eppley BL, Summerlin DJ, Snider R, Jackson JR, McCarty M, Badylak SF. Small intestinal submucosa: utilization as wound dressing in full-thickness rodent wounds. Ann Plast Surg 1995; 35: 381-388.
Sacks MS, Gloeckner DC. Quantification of the fiber architecture and biaxial mechanical behavior of porcine intestinal mucosa. J Biomed Mater Res 1999; 46: 1-10.
Voytik-Harbin SL, Brigtman AO, Kraine M, Waisner B, Badylak SF. Identification of extractable growth factors from small intestinal submucosa. J Cell Biochem 1997; 67: 478-491.
>Acta Ortopédica Mexicana
>Year 2002, Issue 3